Connor Nickel, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

10721 W Indian School Rd
Avondale, AZ 85392-5636

Phone

(623) 772-7748

Fax

(623) 772-7749

NPI assigned

Jun 7, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Desert Edge Physical Therapy LLCGroup PAC ID 6901168400, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Desert Edge Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Peoria, AZ
  • NPI 1710487707
  Medicare reassignment Care Compare group NPD
• Arizona Luna Care Physical Therapy, LLC

  • Physical Therapist
  • Peoria, AZ
  • NPI 1629698147
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646092800000",
    "number": "1548837743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14287 N 87TH ST STE 220",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852603698",
            "telephone_number": "602-329-8250",
            "fax_number": "480-565-1898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10721 W INDIAN SCHOOL RD",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853925636",
            "telephone_number": "623-772-7748",
            "fax_number": "623-772-7749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKEL",
        "first_name": "CONNOR",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-07",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Son T Nguyen, DDS
• Berinyuy Rita Ngwang
• Hannah Nichols
• Kathleen A Nichols, MD
• Mary Nichols, PT, DPT
• Sara Nicodemus
• Hope Nicolaides
• Cory Jay Nielsen
• Trent Nielsen, DDS
• Stan Nikitin, PHARMD

• Physical Therapist in Avondale, AZ
• Providers in Avondale, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.